20160208

The film Anomalisa is playing in my local theater, and it is a straight-up f*ing masterpiece. I'm late to this party, as the film premiered last year and has won several awards. This post is not intended add to the already extensive and overwhelmingly positive analyses of professional film critics, but rather to articulate my personal engagement with the film as a neuroscientist.

The film is animated entirely in stop-motion, and is written by Charlie Kaufman, who also wrote Eternal Sunshine of the Spotless Mind and directed Synechdoche, New York. It follows a middle-aged author on a conference trip, and at first glance would appear to be a surrealist exploration of the mid-life existential crisis in the spirit of Lost in Translation. However, the film is much deeper than that, is in fact a rigorous and scientifically accurate first-person portrayal of a fascinating neurological condition. Everything, from the writing to the choice of format (stop-motion animation), is meticulously designed toward this end.

At the outset, the audience experiences a level of disquiet that mirrors the experience of the main character, Michael Stone. The stop-motion animation is surreal. Dialogue is stilted and devoid of warmth. The timing is subtly and consistently off, and everyone seems to be making too much or too little eye contact. Apart from Mr. Stone, the various characters appear boring, generic, and frequently of ambiguous gender. All characters are voiced by David Thewlis, including, even, the vocals in the musical soundtrack. These choices at first appear to be entirely stylistic, weird and whimsical for its own sake, à la Wes Anderson. We empathize with Mr. Stone's restlessness and ill-ease, and to attribute his detachment and disorientation to existential depression.

Over the course of the movie, Mr. Stone is revealed to exhibit unambiguous symptoms of both the Fregoli
and Capgras delusions.
(As a heavy-handed hint to this, the movie takes place inside the fictional "Fregoli" hotel.) Briefly, the Fregoli delusion involves the belief that everyone else is in fact the same person, and the Capgras delusion involves the belief that
people close to you have been replaced with dopplegangers (cf. pod people).
Both are disorders of familiarity. In the Fregoli delusion, there is
an incapacity to distinguish between individuals. In the Capgras delusion, the processes for recognizing loved ones fail. Absent the expected sense of familiarity, patients reason post-hoc that those close to them have been replaced, or that all other people are one and the same. These disorders are a fascinating reminder that many cognitive capacities that we take for granted, like the sense of connection to others and the sense of self, have specific neurological underpinnings that can be selectively eliminated. Such observations are important, as many enigmatic aspects of consciousness are incorrectly treated as "irreducibly complex" emergent features of the brain.

Both the Fregoli and Capgras delusions can be caused by deficits in the visual processing of faces (facial agnosia AKA prosopagnosia), which is needed both to recognize others and to detect social cues. Congenital facial agnosia is common enough, famously experienced for example by the late Oliver Sacks. It not usually debilitating, because affected individuals can still recognize others based on voice and cues like birth-marks or hairstyle. Mr. Stone, however, displays much more serious deficits. His condition appears to be acquired, as he references having lost and regained his capacity for familiarity in the past. The first instance caused the inexplicable breakdown of a serious relationship, which is revealed to be an unresolved trauma for both Mr. Stone and his previous partner. He attempts (and fails) to reconnect with her, hoping to recover a sense of familiarity which he has, once again, lost. This second time, he has left a wife and child emotionally stranded.

Involvement of the facial processing areas of the brain is made explicit
in a scene in which Mr. Stone examines his own face in the mirror.
Michael sees his face distort and flicker rapidly between incoherent expressions.
You can partially experience this effect using the flashed face distortion effect
(GIF), which is conjectured to confuse the facial processing centers of the brain by (1) forcing you to use peripheral vision, which has relatively lower resolution and (2) tricking the brain's attempts to adapt to stimuli by changing faces rapidly, potentially overlapping in mechanism with other after-effect illusions, and illusions caused by rapidly changing visual stimuli like flicker-phosphene geometric hallucinations.

The homogeneity of the voice acting is revealed to be no mere aesthetic choice,
as Mr. Stone frequently exhibits difficulty recognizing familiar voices
(phonagnosia). The
stilted social interactions seen in the film indicate more general
social-emotional agnosia. Inability to process facial expression and verbal tone
impairs social interaction, leading to a subjective impression of distance
and flatness in the people Mr. Stone encounters. Realizing that Mr.
Stone is suffering from social-emotional agnosia, we understand that the
hotel clerk is not in fact detached and socially awkward, but that Mr. Stone
has, due to his neuropsychiatric condition, been cut off from the world of
human warmth. In keeping with the tradition of of pairing greek roots with 'agnosia' (ἀγνωσία, non-knowledge), we might describe Mr. Stone's condition as a more general oikioagnosia (from Greek, e.g. οικείος 'familiar', οικειότητα 'intimateness').

From Michael's viewpoint, other people are awkward, flat, and annoying, and he responds to them with well-justified irritation. The film never depicts Mr. Stone from the perspective of secondary characters, but if it did we would find Mr. Stone irritable, reacting to friendly human interactions with unjustified hostility. To others, his behavior would appear as a personality change, which can be a troubling early sign of dementia. This is an important comment on the fact that variations in personality need not arise form differences in values, reason, or sense of "self" per se. Changes in our abilities to perceive and interact with the world can alter the information available to us for social decision making and emotional processing. It is a common psychological shortcut to attribute failure in others to "irrationality" or "moral weakness", and this illustration reminds us that differences in lower-level cognitive capacities can also lead to changes in behavior even if high-level rationality and values are unchanged.

While looking for a toy for his son, Mr. Stone mistakenly visits
a sex-toy shop. This mistake is surprising, as he clearly gazes in the window
for several seconds, and fails to realize the nature of the store even once
inside and confronted with a wide display of "toys". Viewers are
left wondering: perhaps Mr. Stone is simply exhausted and too preoccupied to
register his surroundings? In context, this is another manifestation of Mr. Stones agnosia. Something is seriously wrong with our main character. In fact, the reason Mr. Stone is visiting a sex shop in the first place is that he was unable to detect verbal tone. A cab driver had told him that there was a "toy" store near his hotel. But of course both the audience and Mr. Stone can hear only that there is a toy store. Inability to pick up on tone and sarcasm can be early symptom of dementia.

The pervasive and progressive nature of Mr. Stone's agnosia points to a serious neurological issue, either involving an impairment in registering familiarity at a fairly high level, or more widespread degradation of the temporal lobe. It is tempting to attribute Mr. Stone's condition to early signs of dementia, but the existence of an early-life episode that (at least temporarily) resolved needs to be explained. As another clue, Mr. Stone is experiencing night sweats. In any case, Mr. Stone needs to see a doctor as soon as possible.

Anomalisa systematically leads viewers to interpret the consequences of Mr. Stone's condition as anomalies of the fictional universe which he inhabits and the artistic style of the film. Thus, we are lead naturally into the same delusions as our main character: that something is severely wrong with the world, and that something surreal or supernatural is afoot. The stop-motion format forces us to suspend disbelief just enough that additional departures from reality fly under the radar. Apart from lending this beautiful uncanny-valley effect, the stop-motion animation facilitates another brilliant device. The models are 3D printed, and facial animation is accomplished by swapping out the pieces of the model depicting the lower and upper face, controlling the contribution of the mouth and eyes to emotional expressions respectively. Ingeniously, all characters with the exception of Mr. Stone himself, and a woman "Lisa" that he meets (whence Anomalisa), are animated using the same set of facial models. This effect is subtle, as clothing, height, and hair styles vary between characters. The audience automatically misattributes the homogeneity of secondary characters to the animation method.

Mr. Stone's condition has widespread consequences in his personal life. Cut-off from familiarity and warmth, he declares that he has "lost his love". He searches desperately for understanding, to regain the sense of familiarity that he has lost for his wife and son. He seeks connection in ex-partners and
strangers. A woman "Lisa", whom he meets at the hotel, is utterly
generic, with some exceptions. Lisa, like Mr. Stone, is given her own, more realistic and expressive, set of facial models, and the character is voiced not by David Thewlis but by Jennifer Jason Leigh. To Mr. Stone, Lisa is an "anomaly", a breath of fresh air -- the only other real person in the world.
It is implied that the capacity of Lisa to trigger recognition and familiarity for Mr. Stone stems from a prominent facial scar on her face. This scar provides a salient cue that bypasses Mr. Stone's degraded capacities for recognition. The effect is temporary, and over time even Lisa reverts to the homogenous voice of the other characters.

Michael's agnosia has an underlying, organic, neurological cause, but it is his inability to comprehend his impairment leads him to misattribute internally generated errors as coming from extrinsic causes. He misattributes loss of familiarity for his family to lost love. He misattributes his inability to register individuality to a failure of other people to be dynamic or responsive. Ultimately unable to make sense of his impairment, his is lead to the logical conclusion that the nature of reality has shifted, that all other persons are one and the same, and that there is some conspiracy.

At the conclusion of the film, and after suffering an acute nervous breakdown, Mr. Stone returns to his family. His wife has arranged a "surprise party" (really, an intervention). The assembled crowd affirms to Michael that they love him, and that they don't want him to leave. Sadly, Michael proclaims that he recognizes no-one. It is in this last moment that it becomes glaringly obvious that the peculiarities of the film relate entirely to Michael's neurological condition, and that his friends and family have realized that they are losing him. The scenario will be familiar to anyone who have loved someone who suffers from Alzheimer's disease.

Anomalisa is a work of art. It illustrates how delusions and personality changes can arise from low-level neurological impairments, and provides a clear example of how variation in subjective experiences and our collective grips on consensus reality might arise. The narrative is presented such that the audience's experience with the film mirrors Michael's experience with his neuropsychiatric condition.
The choice of format uniquely enables a subtle and gradual departure from
reality that leaves us wondering, even up to the end, whether it is us or the
rest of the world that has gone astray.